The case of the blurred disc margins
Managing blurred disc margins can present a challenge for ODs
A 16-year-old female was scheduled for her periodic ophthalmic evaluation to update her spectacle lens prescription. At the visit, she reported a history of migraines, but the remainder of her personal and family medical history was non-contributory. She took no medications and had a history of low hyperopic refractive correction.
On examination, her visual acuity was corrected to 20/20 and 20/25 in the right and left eyes. The anterior segments of each eye were unremarkable with applanation tonometry pressures measured at 16 mm Hg.
Dilated fundus evaluation revealed the picture depicted in Figure 1. The presence of blurred disc margins was prominent.
Previously from Dr. Semes: Visual phenomena, decreased vision secondary to occipital lobe infarct
With access to B-scan ultrasonography, we performed a scan of each eye at standard as well as reduced gain. These results are shown in Figure 2.
Optical coherence tomography (OCT) was also performed. Figure 3 shows a presentation of the results for the right eye. The upper left shows a reflectance image of the optic nerve head. The lower left is a representative cross-section through the disc. Note that the elevation is confined within the scleral ring, consistent with optic nerve head drusen (ONHD).
Topographic representation of the disc, color image center right, reflects the elevation seen in the cross-sectional presentation. Note that the scale bar to the right indicates that hotter colors are consistent with greater elevation.
Figure 4 is a composite representing the fundus photo and OCT data for the right eye. Clockwise from the center left are the fundus photo, OCT cross-section and topographic data and the lower right image is a presentation of the data cube emphasizing not only the elevation, but confirming the elevation being confined within the scleral ring.